Healthcare Provider Details

I. General information

NPI: 1396227740
Provider Name (Legal Business Name): TANVI DODIA ACUPUNCTURE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2018
Last Update Date: 09/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

694 SACKETT STREET APT 2
BROOKLYN NY
11217
US

IV. Provider business mailing address

694 SACKETT STREET APT 2
BROOKLYN NY
11217
US

V. Phone/Fax

Practice location:
  • Phone: 312-813-8448
  • Fax:
Mailing address:
  • Phone: 312-813-8448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0054931
License Number StateNY

VIII. Authorized Official

Name: TANVI DODIA
Title or Position: MEMBER
Credential: LAC
Phone: 312-813-8448